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PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
(Swan-Ganz)(Swan-Ganz)
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
I. Indications:I. Indications:a. Diagnosis and evaluation of heart a. Diagnosis and evaluation of heart
disease.disease.
b. Evaluates patient’s response to b. Evaluates patient’s response to
treatment.treatment.
c. Simultaneous assessment of c. Simultaneous assessment of severalseveral
hemodynamic parameters.hemodynamic parameters.
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
Pulmonary Artery Pressure (PAP)Pulmonary Artery Pressure (PAP) Pulmonary Capillary Wedge Pressure Pulmonary Capillary Wedge Pressure
(PCWP)(PCWP) Cardiac Output / Cardiac Index (CO / Cardiac Output / Cardiac Index (CO /
CI)CI) Mixed Venous Oxygen Saturation Mixed Venous Oxygen Saturation
(SVO2)(SVO2)
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
II. PA CathetersII. PA Catheters 4 Lumen catheters4 Lumen catheters
a.a. Proximal lumenProximal lumen - IV infusion, - IV infusion, (blue)(blue) CVP CVP measurement, measurement, venous blood venous blood samples, samples, injection of injection of fluids.fluids.
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
II. PA CathetersII. PA Catheters 4 Lumen catheters4 Lumen catheters
b. Distal lumenb. Distal lumen - PA pressures - PA pressures
(yellow)(yellow)
c. Balloon inflation lumen (red)c. Balloon inflation lumen (red)
d. Thermistor lumen - cardiacd. Thermistor lumen - cardiac
outputoutput
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
II. PA CathetersII. PA Catheters
Others: Multi-lumen PA cathetersOthers: Multi-lumen PA catheters • 5 lumen - • 5 lumen -
fiberoptic lumenfiberoptic lumen• • 7 lumen - pacemaker lumen; 7 lumen - pacemaker lumen; injectate injectate lumenlumen
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
III. Sites of III. Sites of insertioninsertion
• • Subclavian Subclavian VeinVein
Jugular VeinJugular Vein
Brachial VeinBrachial Vein
Femoral VeinFemoral Vein
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
IV. Things to prepare:IV. Things to prepare: adhesive tapesadhesive tapes amplifier/ recorderamplifier/ recorder betadinebetadine cordis sheathcordis sheath critiflo/ intraflocritiflo/ intraflo DD55NSS w/ HeparinNSS w/ Heparin DD55NSS (plain)NSS (plain) glovesgloves
infusion set tubinginfusion set tubing multiple lumen cathetermultiple lumen catheter OS 4x4OS 4x4 pressure bagpressure bag Seldinger/Cook’s Seldinger/Cook’s
needleneedle 3-way stopcock3-way stopcock 10 cc syringes (2)10 cc syringes (2) transducertransducer
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
V. Nursing ResponsibilitiesV. Nursing Responsibilities
A. Before InsertionA. Before Insertion
1. Explain procedure 1. Explain procedure
2. Informed written 2. Informed written consent.consent.
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
V. Nursing ResponsibilitiesV. Nursing Responsibilities
A. Before InsertionA. Before Insertion
3. Assemble equipment / 3. Assemble equipment / suppliessupplies
4. Measure BP, PR and RR;4. Measure BP, PR and RR;
Temperature (CO)Temperature (CO)
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
V. Nursing ResponsibilitiesV. Nursing Responsibilities
A. Before InsertionA. Before Insertion
5. Attach to ECG monitor.5. Attach to ECG monitor.
6. Position: Supine or 6. Position: Supine or
TrendelenbergTrendelenberg
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
V. Nursing ResponsibilitiesV. Nursing Responsibilities
B. During InsertionB. During Insertion
1. Monitor the patient’s 1. Monitor the patient’s ECG.ECG.
2. Stay with the patient.2. Stay with the patient.
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATIONC. After insertionC. After insertion
1. Observe for signs of 1. Observe for signs of
pneumothorax.pneumothorax.
2. Continuous monitoring of chest 2. Continuous monitoring of chest sounds / ECG sounds / ECG
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
Right Atrial Pressure Right Atrial Pressure (RAP)(RAP)
- 2 - 6 mmHg- 2 - 6 mmHg Increased PressureIncreased Pressure
volume overload; Right volume overload; Right heart failure; heart failure; Pulmonary HpnPulmonary Hpn
Decreased PressureDecreased Pressure hypovolemiahypovolemia
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
Right Ventricular Pressure Right Ventricular Pressure (RVP)(RVP)
15 - 25 mmHg15 - 25 mmHg
2 - 8 mmHg2 - 8 mmHg
Increased PressureIncreased Pressure Pulmonary diseases; Pulmonary diseases;
Septal DefectsSeptal Defects
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
Pulmonary Artery Pulmonary Artery PressurePressure
15 - 25 mmHg15 - 25 mmHg
8 - 15 mmHg8 - 15 mmHg
Increased PressureIncreased Pressure left heart failureleft heart failure Pulmonary Pulmonary
edema/embolismedema/embolism
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
Pulmonary Capillary Wedge Pulmonary Capillary Wedge Pressure ( PCWP)Pressure ( PCWP)
4 - 12 mmHg (mean)4 - 12 mmHg (mean)
Increased PressureIncreased Pressure Left Heart FailureLeft Heart Failure Pericardial TamponadePericardial Tamponade Reduced CO2Reduced CO2
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATIONC. After insertionC. After insertion
3. Check for signs of 3. Check for signs of decreaseddecreased
circulation.circulation.
4. Check for signs of infection.4. Check for signs of infection.
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
C. After insertionC. After insertion
5. Document all pressure 5. Document all pressure readingsreadings
including patient’s including patient’s position.position.
6. Troubleshoot 6. Troubleshoot hemodynamic hemodynamic monitoring problems monitoring problemsPROBLEM CAUSES TROUBLESHOOTING
a. Damping ofwaveform / No tracing
Air bubbles / blood /blood clots along theline
Loose connections /disconnections
Kinked catheter Incorrect position of
stopcocks Improper adjustment
of sensitivity control
- complete flushingbefore insertion
- aspirate / never flushair / clot
- check patency oftubings.
- adjust sensitivity- Recalibrate
6. Troubleshoot 6. Troubleshoot hemodynamic hemodynamic monitoring problems monitoring problems
b. Failure to wedge Balloon rupture - NEVER inflateballoon
- Indicate balloon isruptured. “ NoWedging”
PROBLEM CAUSES TROUBLESHOOTING
6. Troubleshoot 6. Troubleshoot hemodynamic hemodynamic monitoring problems monitoring problemsPROBLEM CAUSES TROUBLESHOOTING
c. Permanent Wedging
Balloon inadvertentlyinflated
Catheter migration
- ensure catheterdeflation
- turn patient from sideto side
- deep breathing andvoluntary coughing
- refer to doctor
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
C. After insertionC. After insertion
7. Administer oxygen 7. Administer oxygen therapy andtherapy and
medications as ordered.medications as ordered.
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
8. Watch out for complications.8. Watch out for complications.
1. Dysrrhythmias1. Dysrrhythmias-- irritation ofirritation of
heart musclesheart muscles
2. Local infection2. Local infection -- irritation; poorirritation; poor
sterile sterile
techniquestechniques
3. Pulmonary Artery Perforation3. Pulmonary Artery Perforation
-- over-inflationover-inflation
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
8. Watch out for complications.8. Watch out for complications.
4. Pulmonary Infarction 4. Pulmonary Infarction
- frequent prolonged wedging- frequent prolonged wedging
- thrombus formation- thrombus formation
5. Pulmonary Embolism5. Pulmonary Embolism
- over / frequent inflation; air - over / frequent inflation; air embolism embolism
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
8. Watch out for complications.8. Watch out for complications.
6. Endocarditis - mechanical irritation; 6. Endocarditis - mechanical irritation;
bacterial growthbacterial growth
7. Knotting of Catheter - continuous7. Knotting of Catheter - continuous
manipulationmanipulation
8. Pneumothorax - insertion techniques8. Pneumothorax - insertion techniques
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
VI. Responsibilities during removal of VI. Responsibilities during removal of PA linePA line
1. Lidocaine bolus and defibrillation at1. Lidocaine bolus and defibrillation at
bedsidebedside
2. Obtain vital signs2. Obtain vital signs
3. Assess circulation of extremities3. Assess circulation of extremities
4. Deflate balloon 4. Deflate balloon
PULMONARY ARTERY PULMONARY ARTERY CATHETERIZATIONCATHETERIZATION
VI. Responsibilities during removal of PA VI. Responsibilities during removal of PA lineline
5. Monitor for dysrrhythmias5. Monitor for dysrrhythmias
6. Apply firm pressure until bleeding 6. Apply firm pressure until bleeding stops.stops.
7. Apply betadine and dressing7. Apply betadine and dressing
NOTE: PA Catheter to stay for 72 hours.NOTE: PA Catheter to stay for 72 hours.